When Lulu was diagnosed with breast cancer in 2005, she wasn’t thinking about how the disease would affect her and her husband’s sex life.

Staying alive was the first thought of the North Miami woman.

“The moment that I remember the most was standing in the shower holding clumps of hair in my hand. ‘I was like, Wow, now I’m officially a cancer patient,’ ’’ she said.

Lulu had her left breast removed and underwent chemotherapy. Like many women, Lulu, then 44, was pushed into early menopause.

At first, sex was out of the question.

“You have surgery. You’re missing a breast. You’re missing your hair. It wasn’t really on his side; it was about me. I felt disfigured,” said Lulu, now 50, and married for 26 years.

One of the most common side effects of chemotherapy is vaginal dryness, which can cause pain during intercourse. Lulu’s oncologist, Dr. Elisa Krill-Jackson, at Mount Sinai Medical Center in Miami Beach, suggested lubricants. They didn’t work.

Her doctor then recommended that Lulu and her husband see Dr. Christina Pozo-Kaderman, a clinical psychologist and licensed sex therapist at Mount Sinai.

Many doctors don’t bring up sexual issues, either because they are uncomfortable with the topic, or because if they do, and the center doesn’t have a sex therapist, “they’ve just opened up a can of worms,” said Pozo-Kaderman.

It took Lulu a year and a half to be interested in sex again. She learned from Pozo-Kaderman that becoming sexually active again with your partner is a process.

She recommends that women include their lovers in their recovery.

“If you’re going to be sexually intimate, then you need to use a lubricant, and it should be used liberally, and involve the partner in it – have your partner apply it – make it part of foreplay,” Pozo-Kaderman said. Kaderman recommends the brand Astroglide because it is water-based. To keep your vagina moisturized regularly, she recommends also using a vaginal moisturizing cream such as Replens.

“Use it every other night, before bedtime, that way it doesn’t leak out during the day,” she said.

Pozo-Kaderman doesn’t just give technical advice; she gives couples advice on how to spark their sexual desire.

“Part of what I do on an individual basis is give them assignments, such as going with your partner to the different sex toy shops, and shopping for lingerie,” she said.

For Lulu, some of Pozo-Kaderman’s recommendations began with taking walks together, holding hands or cooking dinner together.

“Feel comfortable with yourself first, and feel comfortable with each other second,” Lulu said.

Ada Maria Nimo, 51, of Miami Beach can relate. She found a lump in her left breast in 2002 and had a lumpectomy. She was divorced at the time.

“You’re looking at yourself in the mirror, and you’re seeing someone else,” she said. “Right off the bat, your hair falls out in chunks — it’s incredible.”

Before cancer, Nimo had straight red hair. When her hair started growing back, it was brown and wavy.

“When it comes back, you don’t care what color it is — it could be green — but the fact is, it’s still different than what you’re used to seeing in the mirror,” she said.